What is the difference between HMO and PPO medical plans?
Whenever my health care providers ask me what insurance I have I can never answer. I know that at all my visits (medical, dental, and optometry) I pay a co-pay. Could someone tell me what the difference is between the two? Is one better than the other?
My medical is Kaiser Permanente. My vision is VSP and I choose any eye doctor. My dental is Metlife and I had to go to different places to see which one’s fees would be more covered by my insurance.
Tagged with: different places • eye doctor • health care providers • insurance • kaiser permanente • metlife
Filed under: HMO
PPO means perferred provider–the insurance gives you a list of
doctors you can go to and if you use them, your costs are cheaper. HMO is health maintenance organiztion-Kaiser Permanente being a popular one on the west coast. If you are
insured through a group, like at work, ask your personnel manager if you do not know which type you have.
HMO usually restrict you to seeing only doctors in the HMO organization and may require you to get pre-approval before coming into see the doc. If you get injured out of country, it may be a real hassle getting approval for medical treatment. HMOs have the lowest premiums each month because of the restrictions.
PPOs are Preferred Provider Options and have contracts with different providers who are loosely joined in a network. You can probably see providers outside the network at a higher cost. PPOs usually have higher premiums.
I will never join an HMO because I like to control which doctors I can see. On the other hand, I know lots of people happy with their HMO. I had a rare cancer that I am pretty sure the HMO would never have been able to diagnose since I ended up going to international specialists outside my PPO network to get diagnosed.
hmo’s are cheaper premiums and co-pays but you have less options as to the doctor you will see..
I am not sure, but i believe with PPO you can go anywhere you choose , and HMO it’s only where they accept your kind or insurance, well that is what my mom told me, i don’t even work yet soorrry :’(
with most HMO’s you have to choose a primary care physician (PCP), and all your care is to that physician. If you need to see a specialist, you have to get that PCP to write you a referral. But they co-pays are typically cheaper than a PPO
PPO’s typically let you see any dr you want within their plan, and you can go directly to a specialist, rather than getting a referral. You usually don’t have to choose a PCP at all. However, they tend to be a bit more expensive.
HMO’s in general require you to have a primary med doctor and require referrals for you to see specialists. PPO’s allow you to pick from a list of MD which you can see without referral from another MD. Both have the same goal, controlling medical costs. The choice you make should be determined by your situation and your medical needs.
I literally just went through all my benefit options at the hospital I work for. I chose an HMO, although I previously had a PPO. It really depends on your needs. From the info you gave it sounds like a PPO. With an HMO, the downfall is that you can only go to specific MD’s and Hospitals within a certain network in order for your co-pay to be valid, but the good side is that there is a set rate for everything. I have a $200 deductible and if I’m in the Hospital the most out of pocket expense I’ll see will be $300 (I’m planning on starting a family soon so that’s why I chose this plan), our PPO option had a $500 deductible and about $2-3000, maybe more, out of pocket expense for a hospital stay. Plus the co-pays were higher for that one. And both plans cost the same. When I’m done having babies I’ll go back to a PPO. I hope that helps.
HMO you get a network doctor, PPO you can go with any doctor. Both still have co-pay.